Feed fortification strategy impact on the risk of necrotizing enterocolitis in infants with complex congenital heart disease.

Objectives: Development of necrotizing enterocolitis (NEC) in infants with complex congenital heart disease (CHD) has serious negative clinical outcomes. Unfortified expressed breast milk (EBM) is this high-risk population's enteral feed of choice. EBM often requires fortification to meet nutritional needs to prevent malnutrition. The optimal fortification strategy in this population is unclear. We hypothesize that, in infants with complex CHD at high risk of NEC, using extensively hydrolyzed formulae compared to polymeric infant formulae to fortify EBM will improve growth and reduce the incidence or severity of NEC.

Methods: A single-center, retrospective pre- and post-implementation study was conducted in a tertiary pediatric cardiac surgical center in Queensland, Australia. It observed the impact of a change in fortification strategy and formulae selection practice in infants with complex CHD at high risk of NEC.

Results: There were 133 infants eligible for study inclusion, with 69 pre-implementation and 64 post-implementation. No impact on growth outcomes was observed between pre- and post-implementation cohorts. There was a trend towards reducing the severity of NEC in the post-implementation group. Pre-implementation, 7 out of 17 infants (41%) diagnosed with NEC were classified as advanced NEC, with 0 out of 16 (0%) post-implementation.

Conclusions: The use of extensively hydrolyzed formulae instead of polymeric infant formulae, to fortify EBM in infants with complex CHD at high risk of NEC, has the potential to reduce the severity of NEC, with no impact on growth, across hospitalization.